Preparing for a recent earnings call, David Tusa questioned why his medical waste company, Houston-based Sharps Compliance, posted only about a 20 percent revenue increase since the beginning of its fiscal year.

Why not more? Why not 100 percent?

"I'm always asking why," said Tusa, the company's president and CEO. "I wake up at 2 in the morning, thinking of ways to increase revenue."

Sharps sells mail-back containers for disposal of items such as syringes and unused medicine, and it incinerates narcotics and other items that law enforcement agencies confiscate. Tusa also pursues pharmaceutical companies and recently secured five new contracts to collect medical waste generated by the users of their drugs, which will help track and manage how well patients adhere to their prescribed regimens.

Tusa's focus on expanding revenue sources has helped Sharps post profits in the two quarters preceding the most recent one, a quarter that he says is traditionally slow for the company. Sharps' stock soared for much of last year, too. Although it has cooled off thus far in 2014, the price remains well above its late-2012 low.

And Tusa's performance over three years at the helm earned him the respect of analyst Joe Munda, who has monitored Sharps Compliance since 2010.

"We really like what David has done. He has leveraged what the company has and grown the business," said Munda of Sidoti & Co. in New York.

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Munda, who had downgraded Sharps' rating to "neutral" in 2011 because a government contract was ending and it was unclear how the company would respond, reinstated a "high" rating last year after Tusa's growth strategy started to show results.

Experts have considered Sharps a small-time player in the $4 billion medical waste business. It competes with market behemoth Stericycle, a Lake Forest, Ill.-based public company that reported $570 million in revenues in the first quarter of 2014, up almost 11 percent from $513.8 million in the first quarter of 2013.

Sharps, whose clients traditionally have been small-quantity waste generators across the country, including doctors and home health care providers, recently reported revenue of $5.6 million for the quarter that ended March 31, up from $5.4 million in the same period a year earlier.

The company also reported a $900,000 net loss, compared with a $1 million net loss during the same period in 2013. Tusa said the quarter is typically weak because of the declining flu season, which typically ends in the December quarter. In this fiscal year that ended last June, Sharps posted a $2.7 million net loss, citing termination of that key government contract.

"We were profitable in the September and December quarters," Tusa said, adding that he anticipates a profitable June quarter.

"We are a well- capitalized growing company that is investing heavily in sales and marketing as we are focused on long- term revenue growth and profitability," he said. "We will have occasional loss quarters, which are a result of the investment in sales and marketing over the current quarter sales. It's a long-term growth story as we have a huge revenue growth opportunity in front of us."

Everyone is selling

Tusa, 54, believes potential exists to generate $840 million more in revenue, especially as Americans age and require more care, including injectible medicines. He's trying every method he can to capture the market. Search for "medical waste" on Google, and a Sharps Compliance ad tops the list of search results. While at his veterinarian's office, Tusa examined the medical waste disposal system and convinced the doctor to try Sharps.

Tusa often responds personally to comments and questions posted on the company's Facebook page.

"I have a sales team, but everyone who works here is selling," he said, adding that if he meets potential clients over the weekend, he follows up with them on Monday. "I'm launching a dental campaign right now with three postcards, three letters and three emails. You have to hit them and hit them and hit them."

A Houston native and University of Houston graduate, Tusa has been obsessed with building Sharps since taking control in 2010. Before joining the company in 2003 as its executive vice president and chief financial officer, Tusa was executive vice president and CFO of Billing Concepts, a public telecommunications billing and technology company, and senior vice president and CFO of Serv-Tech, a public specialty services company.

Sharps, which employs 65 people, handles about 500,000 packages a year for small-office generators such as doctors, dentists, tattoo artists and Botox clinics. It also collects and disposes of unused medicine and used paraphernalia for pharmaceutical companies. Sharps' larger clients include national retail businesses such as Walgreens and Brookdale Senior Living Solutions.

The core

In addition to pursuing these larger clients, Tusa is committed to increasing penetration in Sharps' core $648 million small-generator market, which includes 800,000 offices for doctors and veterinarians. So far, he estimates he's tapped into less than 1 percent of that business.

"The biggest challenge is how do you get to them and educate them about what we can do?" Tusa said. "These people have been doing it the same way for years and years. It's all about creating awareness."

Sharps customers receive containers for regulated medical waste, such as syringes, needles, injection devices and expired drugs. After filling containers, customers mail them back to Sharps. The service costs $200 to $400 per month, depending on clients' needs.

"You order what you want and use it as often as you have to," Tusa said. "You pay for what you use."

Tusa, who collects, tracks and reviews client data, said he routinely reviews customers' records to determine whether they got the best deal. He has sifted through clients' medical waste containers, for example, ensuring they don't include regular trash, which quickly fills containers and increases costs.

Tusa said that customer service sets him apart from competitors, adding that "I have a 98.5 percent retention rate. I just have to get in front of them. If I take care of you, you're not going to leave me."

Full service

In another business expansion that drew praise from Munda, Tusa in 2012 began contracting with medical waste pickup provider Daniels Sharpsmart. It helped him gain clients generating small and large amounts of medical waste that had rejected Sharps because it did not offer both pickup and mail-back services.

"Now we don't lose those clients," Tusa said. "We can do it all. It helps with retention."

Munda said the Daniels Sharpsmart deal positioned Sharps as a full-service medical waste company. He also likes how Sharps directly works with pharmaceutical companies to collect unused medicine and used medical waste from patients, which could lead to better medicine compliance and keep people healthier.

"We think those are key selling points," Munda said. "It seems like all the pieces are coming together."